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Human Diseases Yr2 > Anaemia > Flashcards

Anaemia Flashcards

1
Q

How do stem cells turn into B or T lymphocytes?

A

Lymphoid stem cell > lymphoblast > lymphocyte > B or T lymphocyte

B cells mature in bone marrow
T cells mature in thymus

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2
Q

How to blood stem cells turn into Granulocytes?

A

Myeloid stem cell > myeloblast > granulocyte > neutrophil, eosinophil, basophil

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3
Q

how to blood stem cells turn into macrophages?

A

Blood stem cell > monoblast > monocyte > agranulocyte that becomes fixed to a tissue to become macrophage.

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4
Q

how do blood stem cells turn into erythrocytes?

A

blood stem cell > myeloid stem cell > erythroblast > erythrocyte (RBC)

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5
Q

How do blood stem cells turn into platelets?

A

Blood stem cell > myeloid stem cell > thromboblast > thrombocyte (platelet)

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6
Q

What is anaemia?

A

Anaemia is reduced blood cell mass.
It is a reduction in one or more of the major red blood cells (RBC) measurements obtained as part of the full blood count (FBC).

There is a reduction in O2 carrying capacity of blood with resultant reduced O2 delivery to tissues.

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7
Q

What are the two main measurements obtained as part of the full blood count (FBC)?

A
  1. Haemoglobin concentration (Hb)
    > Males 130-170 g/L
    > Females 120-150 g/L
  2. Haematocrit (Htc)
    > Males 0.4-0.54 L/L (40-52%)
    > Females 0.37-0.45 (37-45%)
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8
Q

What is haematocrit?

A

Packed cell volume

  • Vol of blood that consists of intact RBCs
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9
Q

What are the symptoms of anaemia? (3 categories)

A
  1. Neurological
  2. CVS
  3. Musculoskeletal
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10
Q

What are the neurological symptoms of anaemia?

A

Dizziness, fainting, lack of concentration, blurred vision, paraesthesia (peripheral), insomnia, irritability, depression.

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11
Q

What are the CVS symptoms of anaemia?

A

Chest pain (angina), shortness of breath, palpitations, intermittent claudication, heart failure (high output cardiac failure).

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12
Q

What are the musculoskeletal symptoms of anaemia?

A

Fatigability, tiredness, muscle cramps.

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13
Q

What are the signs of anaemia?

A 
Pallor
Tachycardia, bounding pulse, arrhythmias
Postural hypotension
Cardiac failure
Systolic flow murmur
Confusion
Specific anaemias 
 > Koilonychia (ferritin deficiency anaemia)
 > Jaundice (haemolytic anaemia)
 > Leg ulcers (sickle cell anaemia)
 > Bone deformities (thalassaemia)
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14
Q

What are the oral signs of anamaeia? (4)

A
  1. Atrophic glossitis - tongue smooth and depapilliated. looks shiny and smooth
  2. Angular colitis - red cracks at corners
  3. Aphthous ulcers - circular grey/yellow base with red halo. Worse and more frequent ulcers.
  4. Pseudomembranous candidiasis - epithelial cells more fragile, prone to colonisation of commensal organisms.
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15
Q

What is mean cell volume?

A

The size of red blood cells.

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16
Q

What are the different sizes of red blood cells? (3)

What is their MCV?

A

Microcytic - <83fl
Normocytic - 83-96fl
Macrocytic - >96fl

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17
Q

What are the different classes of anaemia? (3)

A

Microcytic
Normocytic
Macrocytic

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18
Q

Name the types of microcytic anaemia (4)

A
  1. Ferritin deficiency
  2. Thalassaemia
  3. Anaemia of chronic disorder
  4. Sideroblastic anaemia
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19
Q

Name the types of normocytic anaemia (4)

A
  1. Haemorrhage
  2. Haemolytic anaemia
  3. Anaemia of chronic disorder
  4. Bone marrow failure
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20
Q

What are the 2 types of macrocytic anaemia?

A

Megaloblastic and non-megaloblastic

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21
Q

Name the types of macrocytic anaemia.

A

Megaloblastic:

  1. Vit B12 deficiency
  2. Folate deficiency

Non-megaloblastic:

  1. alcohol
  2. liver disease
  3. hypothyroidism
  4. Aplastic anaemia
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22
Q

Name the types of megaloblastic macrocytic anaemia

A

Vitamin B12 deficiency

Folate deficiency

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23
Q

What is anaemia of chronic disorder?

A

Anaemia of chronic disorder occurs alongside chronic conditions e.g. tuberculosis, SLE, Crohn’s disease.
It is due to increased inflammatory cytokines e.g. IL-1, TNF-a. These reduce the RBC survival time.

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24
Q

What technique can help with identification of type of anaemia?

A

Blood film

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25
Q

What causes ferritin-deficiency anaemia? (4)

A
  1. Poor dietary intake of iron
  2. Reduced iron absorption
  3. Increased physiological demands
  4. Increased blood loss - CHRONIC BLOOD LOSS
26
Q

What food contains high levels of iron?

A

liver, meat, beans, nuts, dried fruit (i.e. apricots), wholegrains, dark leafy greens.

27
Q

What causes reduced iron absorption

A

Gastritis, coeliac disease, gastric bypass surgery.

28
Q

What causes increased physiological demand (ferritin deficiency anaemia)?

A

Infancy, puberty, pregnancy

29
Q

What causes increased blood loss (ferritin deficiency)?

A

haematemesis, melaena, haemoptysis, severe menorrhagia, gross haematuria.

30
Q

Name some clinical manifestations specific for ferritin deficiency anaemia.

A

Appetite for ice.
Beeturia - ingestion of beets leads to red urine.
Restless leg syndrome

31
Q

What do you look for in a history to find an underlying cause for ferritin deficiency anaemia?

A

GI blood losses
History of gastric or duodenal ulcer disease, H pylori infection, oesophageal varices.
Family history of bleeding disorders. - von willebrand disease. - hereditary hemorhagic telongiectasia.
Family history of chronic malignancy or symptoms suggestive of colonic malignancy.
Multiple blood donations
Marathon running

32
Q

What investigations do you do to identify ferritin deficiency anaemia?

A

Endoscopy: -OGD -colonoscopy

Other investigations as directed by clinical symptoms

33
Q

How do you treat ferritin deficiency?

A

Treat underlying cause
Oral iron supplementation e.g. ferrous sulphate 200mg tds
IV infusion of iron if available if required.

34
Q

What is vitamin B12 ?
Where is it absorbed?
What does it require to be absorbed?

A

Vit B12 is a water soluble vit found in foods of animal origin (meat, liver, fish, dairy).
Terminal ileum
Requires intrinsic factor (produced by gastric parietal cells) to be absorbed.

35
Q

What are the causes of vitamin B12 deficiency?

A
  • Pernicious anaemia (autoimmune with auto-antibodies to either gastric parietal cells or intrinsic factor).
  • Gastrectomy, ileal resection
  • Malabsorption (crohns)
  • Inadequate intake
  • Nitrous oxide anaesthesia
36
Q

What are additional clinical features of ferritin-deficiency anaemia?

A

premature greying of hair
jaundice
skin pigmentation
neuropathy

37
Q

how do you treat vit B12 deficiency?

A

1mg hydroxycobalamin IM injections

initial 5 dose course. Regular 3 monthly injections as needed.

38
Q

Where is folate found?

A

Folate is found in leafy green veg and is destroyed in cooking process.

39
Q

What causes folate deficiency anaemia

A

Main cause is diet deficiency

other causes:
alcohol
folic acid antagonists
malabsorption i.e. coeliac disease

40
Q

How do you treat folate deficiency

A

treat underlying cause

5mg PO folic acid (folate) daily for 4 months

41
Q

What causes haemolytic anaemia?

A

increased destruction of RBCs

42
Q

How can pts with haemolytic anaemia present?

A

jaundice, splenomegaly, gallstones

43
Q

What are the two classifications of haemolytic anaemia?

A

Hereditary haemolytic anaemia

Acquired haemolytic anaemia

44
Q

What are the causes of hereditary haemolytic anaemia?

A

Defects in RBC membrane e.g. hereditary spherocytosis
Defects in RBC metabolism e.g. G6PD deficiency, pyruvate kinase deficiency
Defects in haemoglobin e.g. thalassaemia, sickle cell anaemia

45
Q

What are the causes of acquired haemolytic anaemia?

A

autoimmune haemolytic anaemia
infections e.g. malaria
drugs/chemicals e.g. dapsone, amyl nitrate
mechanical (i.e. prosthetic heart valves)

46
Q

What causes thalassaemia?

A

abnormalities of globin chain synthesis

unbalanced synthesis of a and B globin chains results in precipitation of the chains with both mature RBCs (haemolysis) and RBC precursors (ineffective erythropoiesis)

47
Q

What are the 2 types of thalaessemia?

A

alpha - thalassaemia

Beta - thalassaemia

48
Q

What is a-thalassaemia?

A

reduced or absent synthesis of a-globin chains

49
Q

What is B-thalassaemia?

A

Reduced or absent synthesis of B-globin chains.

50
Q

What is thalassemia?

A

a severe anaemia with markedly reduced MCV.

it is caused by reduced or absent synthesis of globin chains.

51
Q

What is thalassaemia faces?

A

The craniofacial features of thalassemia major patients include larger cheekbones, a rodent or “squirrel-like” face, a depressed nasal bridge, and a protruding maxilla.

BM expansion in children, especially in the skull bones, resulting in ‘hair-on-end’ radiographic appearance.

52
Q

What is the treatment of thalassaemia?

A

blood transfusions
iron collation therapy
sometimes spleen removed if too large

53
Q

What causes sickle cell anaemia?

A

abnormalities of globin chain structure.

There is a point mutation in B-globin gene causing a substitution of valine for glutamate in the B-globin chain. The resulting altered Hb is called HbS.

HbS is insoluble in deoxygenated state and its globin chains crystallise and become rigid taking their sickle shape.

54
Q

What is a vaso-occlusive crisis? (sickle cell anaemia)

A

triggered by cold, hypoxia, GA, infection, dehydration.
bone pain, abdominal pain, dactylitis, cerebral infarction.

cold vessels constrict, block more easily

55
Q

What is anaemia of chronic disease?

When is it seen:

A

a mild, non-progressive anaemia

seen in:
- malignant disease
- chronic inflammation
> infective (TB, infective endocarditis, osteomyelitis)
> non-infective (RA, SLE, Crohns, sarcoidosis, other CT diseases)

56
Q

What is the pathogenesis of anaemia of chronic disease? (3)

A
  1. Reduced release of iron from BM stores to the plasma
  2. Inadequate erythropoiesis in response to anaemia
  3. Reduced RBC survival
57
Q

What is the treatment of anaemia of chronic disease

A

treat underlying disease

58
Q

What is aplastic anaemia?

What is pancytopenia?

A

disorder of stem cells resulting in pancytopenia.

pancytopenia = deficiency of all three cellular components of blood (RBC, WBC, platelets)

results in anaemia, thrombocytopenia (low platelet count) and leucopenia (low WBCs)

59
Q

What are the hereditary causes of aplastic anaemia?

A

fanconi anaemia

60
Q

What are the acquired causes of aplastic anaemia?

A

usually autoimmune, triggered by:

  • drugs/chemicals e.g. cytotoxics i.e. chlorombucil, benzene, NSAIDS, choloramphenicol, carbimaxole, chlorpromazine, phenytoin.
  • infections e.g. TB, viruses (Hepatitis, HIV, EBV, parovirus
  • irradiation.

Human Diseases Yr2 (20 decks)

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